Key result
Targeting a blood pressure of 125/75 mmHg did not reduce death or kidney failure compared to <140/90 mmHg, but significantly slowed GFR decline in patients with proteinuria >1,000 mg/day.
Why the study?
Optimal blood pressure targets in patients with nondiabetic stage 3 to 4 chronic kidney disease were uncertain.
RCT (n=840)
Answers are grounded in this paper and cite their sources.
The Modification of Diet in Renal Disease (MDRD) Study randomized 840 patients, with nondiabetic stage 3 to 4 chronic kidney disease to a blood pressure of less than 140/90 mmHg or to a blood pressure of 125/75 mmHg (1,2). The blood pressures achieved in this study were 133/80 mmHg versus 126/77 mmHg. The mean followup was 2.2 years. This study did not show a difference in death and in kidney failure between the 2 blood pressure groups. However, this study showed that in patients with proteinuria greater than 1,000 mg per day, the lower blood pressure group had a significant slower rate of decline in glomerular filtration rate (1,2).
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Wilbert S. Aronow (2017) conducted an RCT in Nondiabetic stage 3 to 4 chronic kidney disease (n=840). Blood pressure target 125/75 mmHg vs. Blood pressure target <140/90 mmHg was evaluated on Death and kidney failure. Targeting a blood pressure of 125/75 mmHg did not reduce death or kidney failure compared to <140/90 mmHg, but significantly slowed GFR decline in patients with proteinuria >1,000 mg/day.
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